Cardiac Anomalies - is something going on or is this normal?

[samhocking]

Difficult to say what is going on in Belgium & Netherlands with the death of young riders. Is it simply they get reported and there is half a dozen young cyclists deaths each decade in all countries too, but we don't hear about them in cycling press perhaps? Can't believe with social media today, this wouldn't hit most cycling press in each country. UK figures in young people (14-35) shows 12 deaths per week from undiagnosed heart conditions. Niels De Vriendt I read, was said to have had a cardiac screening 2 weeks ago, but what tests I don't know. There are generic tests like ECG & Echo, then there are more involved exercise-based ECG & Echo that can find conditions not found in more basic tests and several more specific tests too.

 

[fmk_RoI]

Here's one we haven't seen before (I think): Serge Pauwels (36, CCC) retires having been sidelined with myocarditis (an inflammation of the heart muscles). He's not strictly retired because of the myocarditis - you tend to recover from that - and his age and the lack of a future for CCC are the real issues here. That said, myocarditis is something we can probably expect to see more of in the months to come, it having become something of a talking point in American college sport as a consequence of Covid:

Daniels said that cardiac M.R.I.s, an expensive and sparingly used tool, revealed an alarmingly high rate of myocarditis — heart inflammation that can lead to cardiac arrest with exertion — among college athletes who had recovered from the coronavirus.

The survey found myocarditis in close to 15 percent of athletes who had the virus, almost all of whom experienced mild or no symptoms, Daniels added, perhaps shedding more light on the uncertainties about the short- and long-term effects the virus may have on athletes.

In Pauwels case, there is apparently no linkage with Covid and his myocarditis had other causes.

(Caveat: there is, as is to be expected, some dispute over whether there is a link between Covid and myocarditis in the first place, and the severity of such a link in the second. Cynically, however, college sport needs to take any link seriously, even if only for the sake of the no claims bonus on their insurance policies.)

 

[F_Cance]

https://twitter.com/i/web/status/1320063321240981511

View: https://twitter.com/barcelofer/status/1320063321240981511

 

[fmk_RoI]

Diego Ulissi (31, UAE), sidelined with myocarditis:

“Diego underwent the normal health checks required by the UCI and the team. Subjectively he was fine and did not feel any disturbance, but the finding of an irregular heartbeat during a physical exertion, not previously present, gave us some doubt,” said team doctor Michele De Grandi. "Even with a normal ultrasound appearance, two new tests (Holter ECG 24 hours, which highlighted further arrhythmias, and a cardiac MRI scan) have drawn a conclusion of myocarditis. Myocarditis is an inflammation of the myocardial tissue, the heart muscle, usually of viral origin. As a precaution, Ulissi will undergo a period of absolute rest for a few months, during which he will carry out in-depth investigations to further clarify the clinical picture.”

Edit - comment from Ulissi:

"The doctors will do further examinations to understand the cause but we can exclude the coronavirus: I've done several blood tests and I haven't developed the antibodies. I'll do more tests in January but with the right care and attention. I still feel i'm an athlete. If I can, I'll be back racing with more determination than ever. However the future seems out of view and I want to focus on the present. I'm going to spend the holidays with my family."

In addition to Pauwels (see above), Romain Zingle (28, 2015) was also diagnosed with myocarditis. Neither Pauwels nor Zingle returned to racing.

 

[King Boonen]

Is myocarditis worth noting here? As far as I'm aware it's not correlated to other cardiac issues that have been discussed and couldn't really be tied to anything clinic related.

 

[fmk_RoI]

Is myocarditis worth noting here?

Short answer? Yes.

This is a thread about cardiac conditions in cyclists. It does not seek to ascribe causes and it certainly does not seek to blame doping. It asks a question, and - over time - presents evidence that may help answer that question, or (more likely) demonstrate why an answer is not as simple and straightforward as those for whom doping is the be all and end all of sport would like us to believe.

If we start excluding conditions because they don't appear to fit a doping narrative what does that achieve? Aren't we then entering into a world of fitting the evidence to the crime, a world of confirmation bias? And how do we choose the conditions to include or exclude? Should the PFOs already listed be delisted, as well as the cases of myocarditis?

Specifically WRT to myocarditis, is it not true that diuretics have been listed among possible causes of the condition? And is it not also true that undiagnosed myocarditis is thought to the the cause of some proportion of sudden cardiac-related deaths in sportspeople? As we don't tend to get autopsy reports on cardiac-related deaths is it wise to simply say one possible cause should be on the list of conditions of which we should not speak?

 

[Oldermanish]

Patrick Bevin (28, CCC) out of Tour Down Under with cardiac arrhythmia.

Team doc Max Testa:

We had a relatively young, 26 yo die during a crit of some heart failure, 10 years back. He had been recently married and his widow was not disposed to pursue it in depth but he had no history of PED use and had been racing for 3 years. It had me backtracking to other athletes in the neighborhood that dealt with irregular pulse rates or quit. The affected profile was all over the map including a known doper with arrhythmia in his 40's, my brother/runner (non-doper) who overtrained and was diagnosed in his early 30's and has been treated twice, my Son's mother-in law who is very active and post menopausal along with here husband who was/is neither active nor menopausal (he can be overdramatic if that counts). The age groups, genetics and activity levels are inconsistent and would lead me to the uninformed conclusion that many more people died from it over time and it wasn't researched.
IMO that suggests exams for heart anomalies be required at least for NCAA collegiate level sports where schools have medical programs. Lord knows NCAA could make that happen and the data would be valuable. Wait....did I suggest the NCAA would do something that benefits athletes? Sorry.

 

[samhocking]

Several arrhythmia cases in my club, certainly not doping-related afaikt, just seems part of being human and extreme endurance perhaps exacerbates it. Although I think the awareness of it means its tested for. Some were also diagnosed with it during sports science trials they needed medicals for. They didn't know they had it until then.

 

[fmk_RoI]

Elia Viviani (31, Cofidis):

The Italian noted an anomaly in his heart rate while training on Sunday, and he contacted his former Liquigas team doctor Roberto Corsetti, a specialist in cardiology and sports medicine. Corsetti in turn referred Viviani to the Ospedali Riuniti in Ancona. Viviani was assessed there by Professor Antonio Dello Russo, who treated Mario Cipollini for a myocardial bridge in late 2019.

 

[fmk_RoI]

This one I missed in October: Viviani's Cofidis team-mate Fernando Barceló (25) suffered a tachycardia episode during the fifth stage of the Vuelta (Huesca to Sabiñánigo), his heart hitting 230 bpm. Following his withdrawal from the race surgery to resolve an issue with a vein in his heart was recommended and carried out.

https://twitter.com/i/web/status/1320063321240981511

View: https://twitter.com/barcelofer/status/1320063321240981511

Much to my regret tomorrow I will not start in @lavuelta According to the team doctor, I have to do some medical tests to rule out any heart problems after suffering a tachycardia today in competition Good luck to the boys of @TeamCOFIDIS in what remains

 

[fmk_RoI]

Add Zdeněk Štybar to the list. Not sure if I've come across this before or if it's just the way the release is worded:

Following his appearance at last week’s Gent-Wevelgem, Zdenek Stybar reported to the Deceuninck – Quick-Step medical team that he was feeling unwell.

After an investigation by our medical team, it was revealed that the rider from the Czech Republic was suffering from a heart rhythm problem, for which it was recommended that he would undergo an ablation procedure. This procedure was successfully carried out by Professor Pedro Brugada, on Wednesday, at a Brussels Hospital.

Zdenek has now been cleared to return to training this weekend but it is felt that this Sunday’s Ronde van Vlaanderen would be too early for him to return to competitive racing, so instead he will take some days off to spend time together with his family.

Edit: Ok, so both Viviani and Ulissi have been treated with an ablation procedure this year. I've been paying attention to how the cardiac conditions have been categorised, not the treatments. Not sure if Steimle - like Štybar, a Deceuninck rider - got the same procedure when he was treated in Brussels last year.

 

[fmk_RoI]

One of the reasons this list of cardiac cases exists is to add perspective whenever one of these cases arises. We have a tendency to remember selectively other cases and that can lead us to thinking there's more of this about than there really is.

But one of the problems with a list like this is the completeness illusion: you see a list, you think it lists all the relevant data. But, in reality, it doesn't. Case in point: Romain Sicard (33, Total Direct Énergie), who has thrown in the towel on his career having first been diagnosed with an undisclosed cardiac condition three years ago and having been off the bike since the beginning of February this year.

TDÉ boss Jean-René Bernaudeau credited the FFC's health checks - introduced around the time of the Festina affaire - in identifying Sicard's condition:

"Today, the health monitoring of our riders is working. The exams are even more extensive than before. This allows them to have guarantees on the practice of their sport. The FFC’s medical check-up revealed a cardiac pathology in Romain that was incompatible with the pursuit of his activity as a professional cyclist."

 

[BlueRoads]

What makes me - a medical layman - wonder is why do they detect these things in riders 30+?
I get that there are many normal people living with certain heart conditions that only get detected in a pro athlete's check-up or when pushed to the limit, but are there that many heart conditions that only evolve with time?

 

[Parker]

What makes me - a medical layman - wonder is why do they detect these things in riders 30+?
I get that there are many normal people living with certain heart conditions that only get detected in a pro athlete's check-up or when pushed to the limit, but are there that many heart conditions that only evolve with time?

Because these things don't happen overnight. They are the result of long term stress to the heart. The same with mental issues in sports where there are players are repeatedly hit on the head. No-one got dementia in their 20s from one whack on the head.